Ethical theory: No Good Deed Goes Unpunished

Matt was assigned to survey Community Medical Center (CMC) in Anytown, Minnesota, with a team of three surveyors and one observer. He related to me his experience of surveying the children’s dental clinic. Following his tour of CMC’s dental clinic, Matt reviewed with the clinic’s staff the dental program, which served the city’s underserved children. He also reviewed the care rendered to several patients based on common and complex diagnoses, as well as the clinic’s performance improvement activities. During the survey, Dr. Seiden, the clinic director, asked, “Are surveyors trained about the importance of dental care in disease prevention? As you know, dentistry is often a stepchild when it comes to allocation of scarce resources. Departments like surgery and radiology often receive the lion’s share of funds.” Matt responded by describing a film sponsored by the American Dental Association that was shown when he was in training to become a surveyor. The film presented a man whose dental care had been sorely neglected throughout his life and not been addressed prior to replacement of a heart valve. The patient developed a systemic infection following surgery, which led to deterioration of the heart valve and the patient’s ultimate death. The film described the lessons learned and opportunities for performance improvement that included the need for a dental evaluation by a dentist prior to valve replacement. Dr. Seiden was pleased to learn that the importance of dentistry is included in surveyor training. Following Matt’s survey of the dental clinic, the staff relayed to him their concern that the clinic was going to be closed for lack of funds. Cheryl, the clinic manager, explained, “I sometimes feel the importance of the dental clinic to the underserved population is not well-understood.” A bit emotional, Cheryl said, “Matt, have you surveyed other dental clinics?” Matt replied, “Yes, several well-funded clinics that come to mind were in Philadelphia and New York City.” Cheryl then asked, “Matt, do you have any ideas as to how we can save our clinic from closing?” Matt replied, “I have some time before lunch, and I can share a few ideas with you.” Cheryl replied, “The staff will be eager to listen.” The staff proceeded to place several chairs in a semicircle and brainstormed with Matt a variety of ideas for saving the clinic. The staff discussed several fund-raising activities including a car wash by children to bring awareness to Anytown’s dental clinic. Matt looked at his watch and said, “I need to get back to my survey team, but I want to leave you with one other thought to ponder that could be applicable to any department in the hospital. I was surveying a veteran’s hospital physical therapy department and noticed on their bulletin board the staff’s dream plan for renovation of their department. I asked the physical therapy staff about the plan. They related how their vision of a new physical therapy department had been sketched out and placed on their bulletin board. Several weeks later, a veteran who had been sitting in the waiting area became curious about their dream. After studying the board during his visits for therapy, he walked to the reception desk on his last visit and asked about their vision for physical therapy. They explained it was a $200,000 dream. Gary looked at the staff at the reception desk and said, ‘It is no longer a dream. I don’t have much, but what I do have is enough to make your dream come true.’ And so, he did.” Matt continued, “You see, if people know your dreams, something as small as a bulletin board can make all the difference.” Dr. Seiden smiled and said, “I see where this is going: community awareness as to the need to fund the clinic. It’s not merely about a car wash, it’s about a concept of how the hospital can save not only the dental clinic but other programs earmarked for closing.” Matt smiled, as the staff regained hope. Dr. Seiden, seeing that Matt had little time for lunch, stood up, extended his hand, and said, “Matt, you gave us hope when we believed there was none. Thank you so much. I will be sure to discuss this with administration. “Matt presented his observations the following morning to the organization’s leadership, which included his roundtable discussion with the staff. He was, however, cut short in his presentation by the surveyor team leader, Brad, who later reported to Victor, Matt’s manager, that Matt should not be discussing how to save a dental clinic by opening a car wash. Matt received a reprimand from Victor and was removed at the end of day 4 of a 5-day survey without explanation.

1. Matt’s approach to addressing the staff’s concerns for saving the children’s dental clinic.
2. If Matt’s roundtable session led to saving the clinic, was Matt’s reprimand worth the risk if he could have foreseen the resulting reprimand?
3. The goal of a consequentialist is to achieve the greatest good for the greatest number. Discuss how this applies in this Reality Check.